Documente Academic
Documente Profesional
Documente Cultură
Colectarea datelor
Strategii de masurare
Obiective
Stabilirea tipurilor de variabile
Surse IT de date
Identifica si localizeaza seturile corecte de date
In institutie
In afara institutiei
Strategii de masurare
Analiza, interpretarea si raportarea rezultatelor
Tipuri de variabile
Variabile de
confuzie*
Predictor*
Rezultat
Modificatori ai efectului*
*Considerate general ca expunere la factori de risc
Studii descriptive
Studii cu 2 variabile
Experimente
Studii observationale
Meta-analize si review-uri sistematice
Studii clinice
Descriptive
Analitice
Experimentale
Observationale
Cohorta
Caz-control
Cross-sectional
Variabile
Variabila predictor
(independenta)
Variabila rezultat
(dependenta)
Realitatea
Cercetarea asupra eficientei de tratament
face subiectul unui numar mic de articole.
Evidence based medicine este considerat un
concept ce foloseste baze de date inclusiv
studii sistematice de caz pentru a ghida
interventii terapeutice.
Dovezile trebuie evaluate intr-un context
terapeutic efectiv, Ce tip de interventie
capata sens pentru mine ca practician?
Clinical Questions
What is the best choice of therapy
for my patient?
Is this program theoretically sound?
Does this therapy program work?
How long with the therapy take?
Where do I go from here?
Baseline Measurements
A baseline is a measure of response
rates in the absence of treatment
Baselines
Establish a need for treatment
Document improvement
Allow us to modify if we dont see
improvement
Baseline Data
Create a set of exemplars of each of your
targets and prepare a recording sheet.
Utilize criterion referenced measures.
Research/Clinical Designs
ABA designs
Test, treat and test
ABAB designs
Test, treat, test and treat
Time-Series designs
Establish stable baseline
Begin treatment
Measure treatment results
Multiple-Baseline designs
Have a number of different baselines
Each baseline must be independent of the others
Only treat one variable
Reliable
Valid
Responsive
Universal
Unbiased
Different judges?
Inter-rater reliability
Sampling Methods
Systematic Sampling
Stratified Sampling
4. Cluster Sampling
5. Convenience Sampling
6. More complex sampling
Variables types
1.
2.
3.
4.
Scale of Data
1. Nominal: These data do not represent an amount or quantity (e.g.,
Marital Status, Sex)
2. Ordinal: These data represent an ordered series of relationship (e.g.,
level of education)
3. Interval: These data is measured on an interval scale having equal
units but an arbitrary zero point. (e.g.: Temperature in Fahrenheit)
4. Interval Ratio: Variable such as weight for which we can compare
meaningfully one weight versus another (say, 100 Kg is twice 50 Kg)
Independent Variable
The characteristic being observed and/or
measured that is hypothesized to influence an
event or outcome (dependent variable).
NOTE
The independent variable is not influenced
by the event or outcome, but may cause it
or contribute to its variation.
Dependent Variable
A variable whose value is dependent on
the effect of other variables (ie.,
independent variables) in the
relationship being studied. Synonyms:
outcome or response variable.
NOTE
an event or outcome whose variation we
seek to explain or account for by the
influence of independent variables.
Intermediate Variable
A variable that occurs in a causal pathway from
an independent to a dependent variable.
Synonyms: intervening, mediating
NOTES
it produces variation in the dependent
variable, and is caused to vary by the
independent variable.
such a variable is associated with both the
dependent and independent variables.
Confounding Variable
A factor (that is itself a determinant of the
outcome), that distorts the apparent effect of a
study variable on the outcome.
NOTE
such a factor may be unequally distributed
among the exposed and the unexposed, and
thereby influence the apparent magnitude and
even the direction of the effect.
Organizing Data
1.
2.
3.
4.
5.
6.
7.
8.
9.
Frequency Table
Frequency Histogram
Relative Frequency Histogram
Frequency polygon
Relative Frequency polygon
Bar chart
Pie chart
stem-and-leaf display
Box Plot
Frequency Table
Suppose we are interested in studying the number of
children in the families living in a community. The
following data has been collected based on a random
sample of n = 30 families from the community.
2, 2, 5, 3, 0, 1, 3, 2, 3, 4, 1, 3, 4, 5, 7, 3, 2, 4, 1, 0, 5, 8, 6,
5, 4 , 2, 4, 4, 7, 6
Organize this data in a Frequency Table!
Frequency Table
X=No. of Children Count
(Freq.)
Relative Freq.
2/30=0.067
3/30=0.100
5/30=0.167
5/30=0.167
6/30=0.200
4/30=0.133
2/30=0.067
2/30=0.067
1/30=0.033
Frequency plot
Frequency Table
Now suppose we need to construct a similar frequency table for the
age of patients with Heart related problems in a clinic.
The following data has been collected based on a random sample of
n = 30 patients who went to the emergency room of the clinic for
Heart related problems.
The measurements are: 42, 38, 51, 53, 40, 68, 62, 36, 32, 45, 51, 67,
53, 59, 47, 63, 52, 64, 61, 43, 56, 58, 66, 54, 56, 52, 40, 55, 72, 69.
Frequency Table
Age Groups
Frequency
Relative
Frequency
32 -36.99
2/30=0.067
37- 41.99
3/30=0.100
42-46.99
4/30=0.134
47-51.99
3/30=0.100
52-56.99
8/30=0.267
57-61.99
3/30=0.100
62-66.99
4/30=0.134
67-72
3/30=0.100
Total
n=30
1.00
Empirical Rule
For a Normal distribution approximately,
a) 68% of the measurements fall within one standard
deviation around the mean
b) 95% of the measurements fall within two standard
deviations around the mean
c) 99.7% of the measurements fall within three
standard deviations around the mean
Prerequisite Skills
Fundamental concepts of measurement
Scales of measurement
Distribution, central tendency, variability,
probability
Disease prevalence and incidence
Disease outcomes (eg, fatality rates)
Associations (correlation or covariance)
Health impact (eg, risk differences and ratios)
Sensitivity, specificity, predictive values
Scales of Measure
Variability, Probability
Mean
Median
Mode
Standard deviation
Statistical Significance p < .01
Confidence Interval
Statistical Significance
Type I and Type II errors
Null Hypothesis = Ho
Ho True
Ho False
Reject Ho
Type I error
Correct
decision
Do Not Reject
Ho
Correct
decision
Type II error
Incidence
Sensitivity, Specificity
sensitivity =
a / (a+c)
specificity =
d / (b+d)
Patients
with
disease
Test is
positive
Test is
negative
Patients
without
disease
Predictive Value
Positive predictive value
= a / ( a+b)
Negative predictive
value = d / (c+d)
Post-test probability of
disease given positive
test = a / (a+b)
Post-test probability of
disease given negative
test = c / (c+d)
Patients
with
disease
Test is
positive
Test is
negative
Patients
without
disease
Diagnosis
Sensitivity and specificity
Predictive values
Likelihood ratios
InfoRetriever
Randomization of patients
Prospective evaluation of patients
Well-defined inclusion and exclusion criteria
Benefits of Randomization
Prevents the systematic introduction of bias.
Minimizes the possibility of allocation bias.
Balances prognostic factors for treatment groups.
Improves the validity of statistical tests used to
compare treatments.
Confounding Example
Relationship between coffee and
pancreatic cancer, BUT
Smoking is a known risk factor for
pancreatic cancer
Smoking is associated with coffee
drinking but it is not a result of coffee
drinking.
What is confounding?
If an association is observed between
coffee drinking and pancreatic cancer
Stratification, or
Adjustment
Randomization: Definition
Random Allocation
Types of Randomization
Standard ways:
Random number tables (see text)
Computer programs
NOT legitimate
Birth date
Last digit of the medical record number
Odd/even room number
Types of Randomization
Simple
Blocked Randomization
Stratified Randomization
Simple Randomization
Randomize each patient to a treatment
with a known probability
Block Randomization
Insure the # of patients assigned to
each treatment is not far out of balance
Variable block size
Stratified Randomization
A priori certain factors likely important
(e.g. Age, Gender)
Randomize so different levels of the
factor are balanced between treatment
groups
Cannot evaluate the stratification
variable
Stratified Randomization
For each subgroup or strata perform a
separate block randomization
Common strata
Outline
Parallel Group
Sequential Trials
Group Sequential trials
Cross-over
Factorial Designs
Parallel Group
Randomize patients to one of k
treatments
Response
Two Scenarios
Study 1
Study 2
Questions to Consider
How do the two studies differ?
Study 1
Study 2
Questions to Consider
Why do the results of different medical
studies sometimes disagree?
Questions to Consider
Suppose a friend recently diagnosed with
brain cancer was a frequent cell phone
user. Is this strong evidence that frequent
cell phone use increases the likelihood of
getting brain cancer?
Experiment
Cross-Sectional
Prospective
Disadvantages of Experiments
They can be ____________ to perform on the
subjects in which you are interested.
It can be difficult to monitor subjects to ensure that
they are doing what they are told.
They can take many years, even decades, to
complete.
Results of experiments that use animals do not
______________ to humans.
They are unnecessary the question of interest does
not involve trying to assess _____________.
Cluster Sampling
Bias in Sampling
A sampling method is _________ if
Types of Bias
Undercoverage
Nonresponse bias
Response bias
Randomization
Example
Example
Important Points
Types of studies:
Undercoverage
Response bias
Nonresponse bias
Convenience sampling
Important Points
If a group is underrepresented in the sample, we cannot
make inference about it.
We must be careful when interpreting the results of
observational studies.
For comparison of several treatments to be valid, you must
apply all treatments to similar groups of experimental units.
Interesting questions are usually pretty tough to answer. This
is due in part to the fact that no single experiment or
observational study can determine causation.